Determining the effectiveness and feasibility of a virtual hospital model of care for low back pain: protocol for a hybrid effectiveness-implementation type-I pilot study (Preprint)

Abstract

Objectives: Low back pain (LBP) was the 5th most common reason for an Emergency Department (ED) visit in 2020–21 in Australia, with >145,000 presentations; 1/3 of these patients were subsequently admitted to hospital. Admitted patient care accounts for half of the total healthcare expenditure on low back pain in Australia. The primary aim of the Back@Home study is to assess the effectiveness of a virtual hospital model of care to reduce length of admission in people presenting to ED with musculoskeletal LBP. A secondary aim is to evaluate the acceptability and feasibility of the virtual hospital and our implementation strategy. We will also investigate rates of traditional hospital admission from the ED, re-presentations and readmissions to the traditional hospital, demonstrate non-inferiority of patient-reported outcomes, and assess cost-effectiveness of the new model. Methods and analysis: This is a hybrid effectiveness-implementation type-I feasibility study. To evaluate effectiveness, we plan to conduct an interrupted time series study at three metropolitan hospitals in Sydney, New South Wales, Australia. Eligible patients will include those aged ≥16 years with a primary diagnosis of musculoskeletal low back pain presenting to the ED. The implementation strategy includes clinician education using multimedia resources, staff champions, and an ‘audit and feedback’ process. Implementation of ‘Back@Home’ will be evaluated over 12-months, and compared to a 48-month pre-implementation period, using monthly time-series trends in average length of hospital stay as the primary outcome. We will construct a plot of the observed and expected lines of trend based on the pre-implementation period. Linear segmented regression will identify changes in level and slope of fitted lines, indicating immediate effects of the intervention, as well as effect over time. Ethics approval has been granted for protocol X21-0278 & 2021/ETH10967. Data will be fully anonymised, with informed consent collected for patient-reported outcomes.